Ramblings from an ER physician in Singapore.
(This blog is a personal journal. Any views or opinions presented on this website are solely those of the author's and do not necessarily represent those of her organization. No part of this website may be reproduced or quoted without the author's expressed permission, written or otherwise.)

Saturday, January 27, 2007

The Volcano Erupteth

It's been -- let's see -- 4 years since my last major meltdown directed at a junior doctor. And boy, did this guy deserve it.

He'd already chalked up a significant degree of notoriety in a previous posting, and proved no different in our ER. The nurses and most of the MOs and seniors have been suffering in silence, with a counselling session thrown in a few months ago, but alas, to no avail.

So today was the proverbial straw that broke the camel's back, I suppose. Me being the camel, haha.

It wasn't pleasant for either of us, and I felt compelled to write a heated email to my fellow senior ER physicians. The last time I resorted to such tactics was during an internal med rotation, when a certain HO routinely switched his pager off ( day and night ), missed all the serial ECGs and cardiac enzymes, and ordered crazy ( not to mention dangerous ) treatments for our hapless, unsuspecting patients.

Fortunately, he bucked up big time after I submitted a formal written report and crucified him, prompting a whole string of consultants ( including the HOD ) to issue a stern warning and a failing grade should he persist.

However, I gave him the credit he deserved, even helping him clerk cases one busy night when I clearly saw how hard he was trying. We parted ways on amicable terms, and I hope he learnt a valuable lesson from the experience, even if he still curses me under his breath now and then.

THIS GUY, on the other hand, doesn't have youthful ignorance as a defense. Nor does he demonstrate any willingness to change for the better. Which is much, much worse.

We've got to clamp down on this nonsense RIGHT NOW, before something really bad happens. Too many sick patients on our hands...

Where's Taylor Hicks?

AI6 is into its 2nd week / 4th episode, and all I can say is: Taylor is one tough act to beat.

Clay Aiken will always be one of my all-time faves, but Taylor has such star quality he's likely to outlast the former ( at least at the rate things are going -- Clay, you need to record a good Christian song album instead of sticking to all those noisy rock/pop pieces ).

I recently caught Taylor on Larry King Live, looking super-lean and full of confidence, and found myself beaming from ear to ear. And Amazon just earned some money from me, since I still can't find Taylor's CD anywhere in Singapore.

But I digress. AI6's "cream of the crop" so far has been rather... disappointing. Sure, there were a few "hot" ones ( in Randy-speak ), but nobody truly stood out, or more importantly, gave me goosebumps.

Taylor did that the first time I saw his audition -- Las Vegas, singing A Change Is Gonna Come, followed by a Ray Charles number. Wow. I pictured him as the Idol winner right then and there. No such vision yet for AI6.

I am, however, watching Jason "Sundance" Head, son of the late Roy Head, who was also a singer ( though I don't know his music ). Sundance has a set of powerful pipes and a very unique look ( stocky, with a long beard and a rather Bohemian style of dressing ). Reminds me a lot of the lead singer from Rascal Flatts. And boy do I like him. :)

My New Fix

He looks like Peter Jackson, but has a Spanish accent. And his films are just WONDERFUL -- even though I've only seen 2 of them. ( Hey, you can tell a lot from just a little. Just look at Christopher Nolan. )

I'm talking about Guillermo del Toro, the 2 films being The Devil's Backbone and Hellboy. The former is a spine-chilling horror thriller ( in Spanish ), the second a superb adaptation of a cult comic series, featuring an unconventional protagonist which looks creepy but manages to earn the viewer's respect and empathy through some seriously nifty character development. Oh, and the action scenes rock! :)

I can't wait to get my hands on Pan's Labyrinth.

And speaking of labyrinth, I just bought Sting's latest release ( Songs from the Labyrinth ) and couldn't even get through the first half. Very tedious, very depressing. This, coming from a diehard Sting fan.

Never mind, am now placing an order for his ( darn expensive ) Sting At The Movies album. Amazon's terrific. :)

Splurge

Why do I always spend more on others than I do on myself when I celebrate? A posh dinner with my parents, a huge catered lunch for the department, perhaps more treats for selected friends and relatives...

Hence my biggest spree on Amazon since... well, ever. Getting pretty sick of the local music scene, which doesn't have what I want. Hip-hop nauseates me, rock gives me a headache, and pop is becoming pure drivel ( Paris Hilton cut a CD -- is this the world I live in? Shoot me now. ).

Will review my new buys in, say, a month. Takes 3 weeks for the package to arrive, but it's well worth the wait.

Wednesday, January 17, 2007

First Things First

I PASSED! Woohoo!

Now that THAT'S out of the way, it's back to reality. In hindsight, I suppose I could've / should've taken more leave, but I'm rather protective of my vacation time so am saving it for a proper holiday later this year.

Pilot episode was terrific, IMHO. Not sure if any of you caught it, but my enjoyment stems mainly from noticing numerous similarities between lead character Doug Hanson and another senior surgeon I know personally.

A memorable line has a young, more sensitive colleague telling a patient, "He won't hold your hand - he doesn't know how." before stating that if it were HIS own daughter, he would trust Hanson with her life.

I can't tell you who the local surgeon is, of course. But he's brilliant, though not exactly a "people person". And just like Hanson, who showed a secret moment of kindness when he whispered words of consolation to a patient who couldn't hear him ( she had an iPod plugged in ), this surgeon did the same thing with one of his own cases, as related firsthand by his assistant in the OT.

Pity it's on indefinite hiatus. I think it's pretty good.

ER Quote

"I find myself searching for reasons not to hate my patients."

-- psychiatrist Div Cvetic, who went on to suffer depression and a mental breakdown, before abruptly quitting and moving to who knows where

There're times when I share this feeling, but it usually passes -- with the help of some vegging out in front of the TV, time spent with friends and family, a holiday, or perhaps, a pay rise ( haha ).

Still, there's nothing else in this world I'd rather be doing. So make sure you choose wisely when it's your turn.

Eric Clapton Rocks!

Unbeknownst to many, I attended the concert, despite it being 3 days away from my exit. I'm not a diehard fan, but went primarily to (1) see the legendary Slowhand in action, and (2) experience what truly great blues really sounds like.

Familiarity with John Mayer's music ( he's widely touted as Clapton's successor ) certainly helped, and I was completely blown away by what I saw and heard. He may be 61 years old, but he's still rocking hard, and gave an energetic performance from beginning to end.

Funny how a bespectacled, nondescript-looking Brit with a receding chin ( I kept wondering how difficult he'd be to intubate, yikes! ) can be hailed as a rock / blues legend. But the 10,000-strong crowd ( a significant portion comprising expats ) was also mostly middle-aged, and boy did they head-bang and gyrate along, especially during the faster numbers.

Pernnial favourites Layla and Wonderful Tonight were done flawlessly, though I prefer the latter and wish he'd opted for the acoustic version of the former instead of all that heavy electric guitar jamming.

Best bit? A short segment after the 1st 2-3 pieces, when he pulled up a stool, switched to an acoustic guitar and did a solo of a classic blues number ( let me know the title 'cos I don't recognize it ).

If only he'd talked a little more instead of zooming through the repertoire, which made everything seem extremely rushed.

Other than that little complaint, I think my money was definitely well-spent. :)

More writing to follow another day. Don't forget to catch American Idol 6 tonight!

Friday, January 05, 2007

5 days into my study leave, and finding it tough to resist temptation. :)

1) ER Re-runs!!!

Yes, believe it! Just started airing on 1st Jan 2007, all the way from the Season 1 pilot! Hallmark Channel 17, 8pm, DAILY.

Do I sound excited? :D

If you're wondering whether I became an ER physician because of this show, then you may be disappointed to learn that the answer is a big "No". I was dead set on O&G ( started from my JC days, but don't ask me why ), then made a big U-turn after discovering a massive distaste for amniotic fluid, placentas and PV exams. That, plus all the screaming ( and sometimes neurotic ) mothers, and a couple of ( this is true ) near-syncopal episodes when the smell and yelling became too potent for my usually strong stomach.

Oh yeah, and nothing quite beats seeing a straining mom defecate during childbirth. Natural, of course, but not something I want to see for the rest of my life. I'll stick to the glam versions on TV / the big screen / in my personal Fantasyland, thank you very much.

Anyway, back to the topic at hand. I was a faithful follower of ER back in my early med school days, though I understood little of the jargon and even less about the complex medical procedures and ACLS / ATLS protocols demonstrated.

Was thinking of renting the entire DVD set after my exam, but thanks to cable, I'm going to save a bundle, heh heh.

Watching it again 12 years later brings back great memories, but more importantly, also illustrates why the series won 22 Emmy Awards and stayed at the top of the TV ratings for eons before being toppled by CSI a few years ago.

The writing is excellent, the actors well-cast, and the resus simulations absolutely the best I've seen EVER. Armed with knowledge and skills from 7 years of clinical practice, I scrutinized the code scenes closely and could find no mistake. Not one! They defib only when its VF or pulseless VT, NOT during asystole or PEA! BRAVO, guys, BRAVO! :)

The only gripe I have thus far is how John Carter -- here a mere M3 -- gets tasked with breaking bad news to a dead boy's family. I don't know if this happens in the US, but it definitely doesn't occur here. Seemed a tad irresponsible on Peter Benton's part, no? But I suppose it does wonders for audience empathy and water cooler conversations.

Just aired the pilot on Tuesday, and although I think it's pretty good, it seems the network decided to pull the plug after what, 13 or 14 episodes?

I'm gonna stick with it anyway, mostly because I like Jeremy Sisto ( the dude who did such a fantastic job playing a sexy, albeit manic-depressive, dude on Six Feet Under ). Here, he's a bounty hunter-type character who shoots to kill without hesitation.

Neurosurgeons take centrestage this time, with the ever-reliable Stanley Tucci in the lead role. You can expect some fireworks from this guy who's done everything from A Midsummer Night's Dream to Maid In Manhattan to Shall We Dance and most recently, The Devil Wears Prada ).

Sadly, I read on the Web that it's been put on indefinite hiatus after just 3 episodes. THREE! Apparently, weekly viewership was considered pathetic by conventional standards ( 8 million compared to the ideal 20 or 30 mill ). Fans are angry, and I'd love to find out why.

Now this is a hot one. Read the site for more details. Due soon on cable's Starworld Channel 18.

5) Law & Order Re-runs

Boy, I'm really looking forward to this!

It's the orginal -- there're spinoffs for L&O: Criminal Intent and L&O: Special Victims Unit ( and I met an American doctor who consults on the shows from time to time, which was cool :)) -- and without a doubt my favourite of the 3. These are old episodes when Jerry Orbach was still alive ( he plays the craggy detective ) but I've always enjoyed the show because of one and only one fellow -- no, not Benjamin Bratt ( pfffft ), but Sam Waterston, who brings great passion and integrity to his prosecutor role.

I used to watch this religiously back in secondary school and JC. Extremely educational ( stories are based on actual cases ), but also one of the most objective and fair in terms of character and plot development.

After Taylor Hicks' dazzling win and the best Top 10 contestants in AI history back in 2006, standards have been redefined and man, is the pressure cooker turned on full blast.

I'm just wondering why Taylor's album hasn't reached our shores a month after its US release. At this rate, I may have to resort to ordering through Amazon again. Hello? Arista Records distributor? Are you awake?

Being -- and Feeling -- Human

Everyone knows we see a lot -- sometimes too much -- in the ER. So it's no surprise that we do become numb after a while. Bloody RTA? Go through the motions of ATLS. 2 guys chopped each other with parangs the other night -- call the trauma team, do a FAST, send for CT, etc. Old lady with non-specific symptoms collapsed just as my MO was prepping for an ABG -- ACLS kicks into gear like a spinal reflex. ( We actually brought her back, woohoo! )

So it was rather unusual when I got a bad case of insomnia Christmas night / Boxing Day morning, after my MO and I attended to a horribly tragic case during our evening shift.

Some details were revealed in a recent Forum letter and follow-up article in the Straits Times -- about a Hainan opera performance at the Esplanade, a bad fall down a dark staircase, fatal head trauma.

She arrived in critical condition: GCS 3, pupils fixed and dilated, features of a severe base of skull fracture. Paramedics provided a short history, so after intubating and arranging an urgent CT, I left resus to speak to her family and friends.

The circumstances of her fall became clear during our conversation, and I certainly shared their pain. A large group of close friends and her sister were present at the same concert, and tears flowed unabated when I explained how dire the situation was.

Maybe the date itself played a significant role. Or perhaps it was her pre-morbid state -- a healthy 55, retired not too long ago, lots of good friends and close relatives, ready to enjoy the rest of her life -- which drove home the fact that life is indeed fragile and unpredictable.

But there was another detail -- about trying to give the ticket away, about the slimmest possibility that she might not have been there that night...